HomeMy WebLinkAboutSWG2023-00423 - SWG As-Built - 4/9/2024 (2) Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
EPeMitNumber SWG 2023-00423 Parcel# 22233-51-00046nt Name Timothy Thatlen Subdivision (Name/Div/Block/Lot)nt Address 90 E.Old Rench Rd.ate,ZIP ANyn,We 99524 Installer Name Arrow Excavationdress 4940 Meson Lake Dr.W. Designer Name Bob Payne
INSTALLATION CHECKLIST
❑ Full System lnete4anon •Tank(s)Only ❑Drainfmld Only 0 Repair O Omer
System Type Pretreatment Type
>Sft.ham foundation? - --------- -- --- ------------- DWA ■Yes ❑ Nd
>50 R from wells? ____ _ __ __ ____ __ __ ____ _ ____ _ _ _ ❑ ❑----------- - --- - -- - - - - - - --- - --- - - -- 0
0ft.fromsurface"ter? - ___ _ __ _ _ _ _ _ _ ___ _ ___ _ _ __ ❑ U Cl
Clsenout between building and tank? - - - - - --- - - -- - -- - - - - 0 ■ ❑
0 Tenkbafos present? --_ ___ __ __ __ _ _ _ _ _ _ _ __ __ ___- ❑ ■ ❑
24-access rivets over seen compartment?-- - - - ----- -- -- -- 0 ■ ❑
Effluent filter installed?_____ ______ ___ __ __ _ ____ __ _ _ ❑ U ❑
Septic tank capacity(v.crldng) 1500 dal Manufacturer I1 &man
�J D-bo%water level and speed levelers used? . __-- - - - - - -- -- - .WA ❑vEs ❑ Na
O ManitolwD.box accessible from surface?- -- - - - - - --- - --- - -
Check valveslnstalled? ------- - ---- - -- - - - -- - - _ - . ❑ ❑
Transport Line Size Schedule/Claee
Bedrooms Installed(check orle) ❑ 2 ❑3 4 ❑5 ❑6 ❑Commerciagotlier
>10ft.Rom foundation?-_____ _ _ ___ __ _ _ ___ _ _ _ _ _ _ _ - ■ era ❑YES 0 N
o >100ftfromweile?- _ -_ __ _ _ _ __ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _- ■ ❑ ❑
>100 ft from surface water?______ _ _ _ _ _ _ _ ___ _ _ _ __ ___ ■ ❑ ❑
>10ft,font potable water lines?- _ _ _ - _ _ _ _ _ __ - __ __ __ __- ■ ❑ ❑
_ >5ft.Ram PrWsrtY Nnes anti easemanta?.____ _ __ ___ _ _ __ -
■ ❑ ❑
a£� >30 ft.from downgradienl curtain/roundetion drams?. - - - - - — _- ■ ❑ ❑
Drainfe/d level and observation pons present -- --- - --- -- _ -- ■ ❑
❑ Greveless chambers or ❑ Clean gravel used? (check one) ❑
Proper cover installed over dralnfield?- - - - -- - - - - -- - -- -- - - - 0 ❑
Pump tank setbacks consistent with septic tank?- ------- - - - - - 0 WA ■ via ❑ No
Pump tank capacity(flood) 1500 cal Manufacturer Hagoerman
24-access nser(s)and accessible from surface?- - - - -- - - - - - - - 0 IN ❑
Alarm or Control Panel Installed?- - - - -- ----- -- --_ _- - ❑ ■ ❑
Control Panel equipped with Tlrner/ETM/Counter- - -- - -- - - -- ❑ ■ ❑
Pump installed in ■ Bucket or 0 On Block or ❑ Other
d Pump Make/Model Little Giant(sods) ■ Floats or 0 Transducer
Tank draw down INmin Pump capacity aprn Squirt Heigh ft
Pump on time Pump of Ome Daily flow set at apd
I oW Ve..
Mason County OSS Installation Report pg.2 Parcel# 22233-51-00046
ABANDONMENT RECORD
Were eweng septic component. abandoned as pan of this project? - -- ----- -- - -- - - ® nno ONo
If M.Please desmbe.
wa,e al components pumped out end propedy abandoned per WAC248-272A-0300? -------• ® vas ❑ NO
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I cemty that I Installed the system in accordance with I colt&that the system hiss,been Installed in actor-
the septic design stamped APPROVED'by Meson dance with the septic design stamped APPROVED-by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared'approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State end Meson County Codes
I further comfy that an Inhumetlon contained on this I further cga/y that all Informatkn contained on this
form and eaeen d Record is to icon and attached Record Drawing is accurate.
4sture of Installer bate
John Gluiand
Rifteed Name ofspwt.e r-,
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Pub/IC rsvlRE6
Heath:
Sig tt re s*w nor t I Heald,Specialist Data (stamp, signatwe and date)
THIS FORM MAY SE SCfl1 AND AVMABLE FOR PUBLIC VIEW ON THE IUSON COUNTVWEB SITE r0a.mwlnM!
APPROXIMATE EXISTING
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